▪ Inadequate intraoperative fluid replacement

▪ Continuing fluid sequestration by tissues (third-spacing)

▪ Wound drainage
▪ Hemorrhage
● Mild hypotension is common during recovery from
anesthesia and typically does not require intensive treatment.
→ A reduction of 20% to 30% below the baseline of a
patient’s blood pressure is significant and requires
correction.
● Confirmed by an increase in blood pressure following the
administration of fluid bolus (250-500 mL crystalloid or 100-
250 mL colloid)
● Treatment
→ Severe hypotension
▪ Vasopressor or inotrope (dopamine or epinephrine)
▪ Invasive hemodynamic monitoring or
echocardiographic examination, and manipulations of
cardiac preload, contractility and afterload – when the
patient fails to respond to initial treatment

2. Hypertension
● Typically occurs within the first 30 minutes after admission
● Often caused by noxious stimulation from incisional pain,
endotracheal intubation, or bladder distention
● Mild hypertension generally does not require treatment,
although a reversible cause should be sought.
● Elevations in blood pressure greater than 20% to 30% of the
Figure 29. Postanesthetic Aldrete Recovery Score (Ideal Score: 10;
patient’s baseline or those associated with adverse effects
Minimum Score required: 9)
(e.g. myocardial ischemia, heart failure, or bleeding) should
be treated.
● Treatment
→ IV β-adrenergic blocker (e.g. labetalol, esmolol,
metoprolol)
→ ACE inhibitor (e.g. enalapril)
→ Calcium channel blocker (e.g. nicardipine)

G. DISCHARGE CRITERIA FROM PACU

● Standards for discharging patients from the PACU are

established by the department of anesthesiology and the
hospital medical staff.
● Criteria may vary according to whether the patient is going to be
discarded to an ICU, a regular ward, the OPD (phase 2
recovery) or home.
● Minimum discharge criteria from PACU:
→ Easy arousability
→ Full orientation
→ The ability to maintain and protect the airway
→ Stable vital signs for at least 15-30 min
→ The ability to call for help, if necessary, and
→ No obvious surgical complications such as active bleeding.

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 APPENDIX

OPIOIDS COMMONLY USED FOR OPERATIVE PAIN

MANAGEMENT

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